When can you be induced with twins?

As a reminder, induction is when the doctor encourages Mom’s uterus to contract and thus start the labor process. Inducing labor may be done via many different methods so talk to your doctor about what that means in your situation.

So that begs the question, when is it safe for Mom to be induced to bring those babies into the world?

Induction of your twin babies is really up to you and your doctor.

You may find that your twins arrive even before you have a conversation about induction.

Twins can be born significantly early, particularly when compared to a singleton child. As we have discussed before, twins are born on average at about 36 weeks of the twin pregnancy. Your doctor may be open to inducing Mom anywhere after that 36 week mark.

In the case of our twin pregnancy, the doctor didn’t want to plan anything until we had reached 38 weeks of the pregnancy. So typically, between 37 and 38 weeks is when the doctor may approve an induction for your twin babies if the twins haven’t already been born by then.

The optimal delivery window depends heavily on chorionicity (whether the twins share a placenta):

You’re going to have weekly checkups with a doctor plus probably weekly ultrasounds to see how the babies are doing. The doctor will be very aware of the the growth situation of the twins and of the health of Mom. These frequent check-ups also give indications of how long those babies can make it before it’s time for them to be born.

Our girls were born at 36 weeks of the pregnancy. We had gone in just for a regular checkup when we found out that my wife was having contractions and it was time to have the babies.

You may find that your twin babies are in no hurry to exit the womb and may then need to be induced a 37-38 weeks. Of course this is a conversation you’ll need to have with your doctor because your doctor best knows Mom’s health condition and baby’s health status and how long those babies can go and still be healthy.

Ideally, you want to keep those babies in as long as possible so they can continue to grow and develop (particularly their lung capacity). But once they’re beyond that 36 week mark, they are usually going to be okay and will be healthy and just fine.

By 38 weeks, it’s probably time for those babies to be induced and to come out.

The induction for twins (especially Twin A) is often considered a “Trial of Labor” (TOL). The mother will be in the delivery room, not a standard labor room.

Once Twin A is born, the doctor will quickly assess Twin B’s position.

Labor continues, but often Twin B needs a minor induction (e.g., breaking the second bag of water, a quick dose of Pitocin) to encourage delivery within 15–30 minutes of the first twin. This is a stressful window of time that parents need to be prepared for.

A successful vaginal delivery of Twin A does not guarantee a vaginal delivery of Twin B. The second twin has a higher chance of needing an emergency C-section if they flip into a breech position after the first twin has exited.

During a twin induction, continuous fetal heart rate monitoring is mandatory for both babies. This means belts or internal monitors will be in place the entire time, which can restrict movement and increase discomfort.

Mom will almost certainly need an IV line throughout the induction and labor, as the risk of requiring immediate medical intervention (C-section, blood transfusion) is higher than in a singleton birth. This is non-negotiable for safety.

Since induction carries a slightly higher risk of leading to an emergency C-section for twins, have a detailed discussion in advance with the OB/MFM about which staff members will be on call and what the operating room prep protocol is if the induction fails. This helps manage anxiety during the transition.

Twin A needs to be head-down (vertex) for an attempted induction. If Twin A is breech, an elective C-section is the standard, safest route.

On your next doctor visit during the twin pregnancy make sure you ask when Mom could be induced if it came to that. You just may hear “38 weeks”. Discuss the details of how that will play out with your partner and the babies.

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